Why children under five are twice as likely to die in the UK as in Sweden

Inequality is a major driver. Kids by Shutterstock

Why do so many young children die in the UK? Child mortality rates in the UK are higher than in many other European countries, and in a study published in Archives of Disease in Childhood we compared mortality rates for children younger than five in the UK and Sweden over a three-year period, from 2006 to 2008. We found that twice as many children under five died in the UK than in Sweden.

The under-five mortality rate is considered by UNICEF to be one of the best indicators of the health of children within any given country. It is determined from the number of deaths per year in relation to every thousand live births. Sweden has one of the lowest child death rates in Europe, but we also chose Sweden as a comparison because like the UK it has free public healthcare and a similar level of economic and social development. The proportion it spends – around 8% – of its gross domestic product on healthcare is also similar to the UK, as is the level of neonatal intensive care. Data came from relevant national agencies from the period.

During the period we studied there were around 2.3m live births in the UK and 315,884 in Sweden. But the mortality rates for newborns (up until the age of 28 days) and children aged under five were all significantly higher in the UK (614 per 100,000) than in Sweden (328 per 100,000). And for the majority of the causes of death – prematurity, respiratory disorders, infections, cardiovascular, central nervous system and blood-related disorders – they were significantly more frequent in the UK.

Premature babies are more of a feature in the UK.
Feet by Shutterstock

Deaths from prematurity, for example, was 13 times greater in the UK, while the risk of death from an infection was almost twice as high in the UK as in Sweden. Respiratory infections, septicaemia and meningitis all resulted in significantly more deaths in the UK than in Sweden, with rates 59-96% higher in the UK.

Social issues

What did our findings mean in relation to provision of healthcare in young children? Well, prematurity is a major cause of mortality in childhood. Socio-economic factors and socio-economic inequalities have a major influence on premature birth. Socioeconomic inequalities, as represented by the GINI index, are greater in the UK than in Sweden and the number of premature births is both higher in the UK than in Sweden and is increasing.

Infections were the third most common cause of death in both countries – but mortality rates from these in the UK were almost double those recorded in Sweden. In the majority of cases the infections were for treatable conditions such as pneumonia and blood poisoning for which we have a variety of effective medicines. As both the UK and Sweden have free public healthcare systems this might suggest concern that within the UK a significantly higher number of young children do not receive timely treatment for life-threatening infections. Many family doctors in the UK also don’t have any specialist training in paediatrics, unlike in Sweden.

The differences in mortality rates for a wide variety of clinical conditions including respiratory disorders in both young children and newborns, and cardiovascular, gastrointestinal and neurological disorders, raise important questions about the organisation and delivery of services for young children in the UK.

So what can we do? Reduce inequalities. This, however, is unlikely to happen – as the main political parties in the UK think austerity is a necessary idea. We could fund more research into service delivery and access. It’s not simply about finding new medicines, but making sure access to them and care services are prompt and available.

Imti Choonara does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

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